Health inequalities: Research Concepts

1
Health inequalities Research Concepts Policy
Goals
What have we learned since the
Black report?
2
relationship between health inequalities research
public health policy
3
relationship between health inequalities research
public health policy

• relationship transformed in last decade
• key terms move across/between research policy
  domain, with research concepts embedded in policy
  goals
• importance of clarity about boundary terms which
  carry research into policy and policy into
  research.

4
Determinants of health
5
Determinants of health

• central to health policy but lack of clarity
  about
• how determinants connect with individual
• difference between the determinants of health and
  health inequalities

6
Determinants of health a cornerstone of policy
7

• new approach to public health which aims to
  improve the health of our people to reduce
  inequalities in healthby addressing the wider
  determinants of health Investing in Health 2000
• improving health the health of the worst off
  in particular by tackling the fundamental
  determinants of ill-health CMO England, 2001

8
Cross-government action will address the root
causes of ill-health health inequalities The
Governments aim is to reduce health inequalities
by tackling the wider determinants of health
inequalities Tackling Health Inequalities a
Programme of Action, 2003 acting on the
determinants of health in order to improve
population health reduce health inequalities
NZ National Health Committee, 1998
9
how determinants connect up to the individual
whose health is being determined
10
standard epidemiological model
social structure
social position
intermediate risk factors
health outcomes
11
The main determinants of health
12

• We have adopted a socioeconomic model of health
  its inequalities. Figure 1 shows the main
  determinants of health as layers of influence,
  one over another Independent Inquiry into
  Inequalities in Health (Acheson report), 1998
• Health well-being are influenced by many
  factors including past present behaviour,
  health care provision wider determinants
  including social, cultural and environmental
  factors Securing Good Health for the Whole
  Population (Wanless II report), 2004

13
But such models leave out social position
14
But such models leave out social position
fundamental social cause of healthaffects
multiple disease outcomes through multiple
mechanisms maintains an association with
disease even when the intervening mechanisms
change Link Phelan, 1995
15

• social position marks the point at which
  societal-level factors enter shape peoples
  lives, influencing exposure to risk factors which
  directly affect their health
• in societies where there are systematic
  inequalities in social position socioeconomic,
  gender, ethnic etc then societal-level
  resources enter peoples lives unequally

16
distinguishing between the determinants of health
health inequalities
17

• the essential role played by the main
  determinants of health in the generation
  development of socioeconomic inequities WHO
  European Health Report, 2002
• The Acheson report examined the determinants of
  health as layers of influenceTackling health
  inequalities will require us to address all these
  layers of influence DH Tackling Health
  Inequalities, 2001
• to reduce health inequalities a multi-faceted
  strategy is required to tackle the economic
  environmental determinants of health Health in
  Wales, CMO Annual Report, 2002

18
Policies across the last 3 decades have been
associated with positive changes in health
determinants but have not reduced inequalities
in their distribution nor been associated with a
reduction in inequalities in health.
19
Health determinant socioeconomic
position

• proportion of population with educational
  qualifications in higher non-manual occupations
  has risen sharply so too has average income.
• policies which produced these positive trends
  have not reduced inequalities in socioeconomic
  position.
• instead, social differentials in participation
  in higher education, in access to secure
  well-paid occupations, in income have all
  widened.

20
Health determinant smoking

• from 1970-2000, prevalence of smoking declined
  sharply.
• but policies associated with this overall
  improvement failed to dent the socioeconomic
  differentials in smoking.
• instead, the gap in prevalence between manual
  non-manual groups has widened

21
This suggests

• distinguishing between the overall level the
  social distribution of health determinants is
  important. The former is key for improving
  population health the latter for tackling health
  inequalities.
• tackling health inequalities turns on reducing
  inequalities in the major influences on peoples
  health.

22
Social determinants of health inequalities
inequalities in social position
inequalities in health
structural inequalities
inequalities in resources risk exposures
23
Post-1997 policies tackling health determinants
their unequal distribution

• changes to tax social security have raised
  average living standards..
• and have been progressive rate of increase has
  been highest in the poorest households, tapering
  away to zero for higher income households.

24
Post-1997 policies tackling health determinants
their unequal distribution

• increased investment in welfare services which
  directly support peoples lives, like health,
  education housing, means that welfare services
  make a more substantial contribution to overall
  living standards. ..
• and this investment has had a differential
  effect, lifting living standards more in poorer
  than richer households.

25
conclusions

• Through open dialogue between research policy,
  research concepts now inform policy goals
• This makes clarity around boundary terms an
  important part of evidence-informed policy and
  practice

26
(No Transcript)